EHR Experts

By:  Elizabeth W. Woodcock

• Government’s payment program for qualified EHRs used in meaningful manner begins Jan. 1, 2011
• Labor costs for conversion are inexpensive, as affordable, skilled staff are plentiful
• Newly-trained dermatologists don’t want to use paper

If you’ve been on the fence about purchasing an electronic health record (EHR) for your dermatology practice, it’s time to make your move. The federal government has pledged billions of dollars to finance the automation of medical practices.

Also working in your favor now are the advances in the technology behind these systems; today’s systems are much better than what you could find just 12 or 18 months ago. Although there are many factors to consider when purchasing an EHR, give special consideration to the following developments and trends:

1. The government’s payment program begins soon. The American Recovery and Reinvestment Act (ARRA) outlined a series of stimuli to get the economy back on track. While most industries have already enjoyed their portion of stimulus package dollars, the healthcare industry is waiting for Jan. 1, 2011. That’s when the first of a series of consolidated bonus payments will be distributed to eligible professionals who successfully use a qualified EHR in a meaningful manner. Available through Medicare (up to $44,000) and Medicaid (up to $63,750), the payments are designed to pay for, or at minimum offset, the cost of an EHR purchase. Although the program is not required, penalties in the form of reduced Medicare payments will begin in 2015.

2.Participation in pay-for-performance (P4P) requires technology. A multitude of payers have introduced P4P programs in the past few years, including the government’s Physician Quality Reporting Initiative (PQRI) and e-prescribing programs. Select private payers also provide bonuses to practices for using technology, and most have programs in which physicians are asked to report on quality indicators. The recent healthcare reform legislation introduces a penalty that begins in 2015 for Medicare providers who do not participate in PQRI. Penalties beginning in 2012 were already in place for Medicare providers who do not use e-prescribing. Even without the prospect of penalties, an EHR is essential for success at patient identification, application of measurements, quality indicator reporting and other tasks that public and private P4P programs require.

3. Going green means getting rid of the paper. Maybe environmental friendliness isn’t at the top of your priority list, but more and more patients are getting on board the sustainability bandwagon and looking for physicians who are eco-friendly. Consider the mounds of paper that your practice uses every day, let alone the file folders, stickers, plastic outguides, shelving supplies and so on. An EHR will never eliminate all paper, but it will reduce the quantity you use significantly. Putting the spotlight on your efforts to go green and embracing technology may just be the marketing edge you need in today’s competitive environment.

4. Labor is cheap for the conversion. Migrating to an EHR requires an investment in managing the transition; consider that each active chart must be converted to an electronic format. Either you do it all at once, or individually, upon each patient’s arrival. Both methods — mass conversion and patient-by-patient — require you to hire extra staff to scan and index records. Even though there are signs that the economy is rebounding, unemployment rates still top 10 percent in most communities. The time is right for hiring affordable and skilled staff to help your practice make the transition to an EHR.

5. Newly trained dermatologists don’t want paper. Recruiting residents to join your practice will be harder than ever if you haven’t surrounded yourself with technology. Unlike prior generations that enjoyed technology as an optional tool, these newly trained dermatologists rely on it. In addition to a recruitment essential, an EHR is an investment in the value of your practice. New physicians aren’t interested in buying stacks of paper charts — they want to purchase information. They certainly aren’t attracted to practices that don’t look capable of keeping up with technology, including those who maintain a staff unfamiliar with automation. Even if you’re not interested in using an EHR, getting one — and using it — may be one of the best investments you can make in the future of your practice. If you share in the financial success of your practice as a business entity, weigh an EHR’s potential benefits for future practice value and revenue against the certain penalties of staying on the fence.

6. Patient flow can be sustained, not hindered. Perhaps the biggest knock on an EHR by dermatologists is its influence — negative, that is — on their workflow. Although some dermatologists are challenged to see the same volume of patients post-EHR implementation as they did in the days of paper charts, there are ways around those bottlenecks.

If typing is the problem, hire a scribe or use voice recognition software. If you feel like the presence of a computer in the exam room is a barrier to or distraction from communicating with patients, work on positive techniques to engage them. For example, try saying, “Ms. Jones, I’d like to record exactly what you’re saying,” or, “Let’s take a look at your test results together, Ms. Jones.” EHR templates that formulate the basis of your documentation are better than ever, allowing more customization and making the technology a better fit with your workflow.

Even if you decide not to use the EHR in the exam room for all patients, the administrative aspects of an EHR can bring another key benefit: a more supportive staff. Instead of looking for pieces of paper — messages, charts and test results — your staff is able to get back to what you hired them to do: help you. Finally, the income you gain from capturing all charges and coding appropriately for the services you perform, over the long run, outweigh any temporary reductions in workflow.

The benefits of an EHR are undeniable for your practice as well as your patients. By taking advantage of the government’s bonus payment program for EHR implementation and use, you can put this technology to work sooner rather than later. The potential of reimbursement penalties and lost opportunities for staying on the fence for very much longer could soon add up to a costly bit of indecision.

Above article publish on http://www.modernmedicine.com/modernmedicine/Modern+Medicine+Now/Physicians-who-adopt-EHRs-now-can-reap-benefits/ArticleStandard/Article/detail/676368?contextCategoryId=40160

Filed under: EHR, Electronic Health Records on July 1st, 2010 | 4 Comments »

Beginning July 1, the Office of the National Coordinator for Health IT will accept and process applications from not-for-profit entities seeking designation as ONC-authorized testers and certifiers of electronic health record technology, Government Health IT reports (Mosquera, Government Health IT, 6/18).

On June 18, ONC released a final rule on a temporary program designed to help ONC approve organizations to test and certify electronic health records under the 2009 federal economic stimulus package.

Under the stimulus package, health care providers who demonstrate “meaningful use” of certified EHRs will qualify for federal incentive payments (Kraynak, HealthLeaders Media, 6/18).

Timeline for Temporary EHR Certification Program

The final rule is scheduled to be published in the Federal Register on Thursday, triggering the official launch of the temporary certification program.

The program is set to end on Dec. 31, 2011, when a permanent and more comprehensive certification program will take its place.

Carol Bean, ONC division director of certification and testing, said authorized organizations are expected to begin testing and certifying EHRs by late summer. By fall, certified EHR products would be available on the market, she said.

Bean added that ONC would announce the authorized organizations on its website (Government Health IT, 6/18).

CCHIT Plans To Apply

The Certification Commission for Health IT, an existing EHR certifying organization, in a statement said it will be among the applicants for the new program. CCHIT officials said the organization is prepared to demonstrate its qualifications and experience (Monegain, Healthcare IT News, 6/18).

Source: http://www.ihealthbeat.org/articles/2010/6/21/onc-to-start-accepting-bids-for-temporary-ehr-certification-program.aspx

Filed under: EHR, Electronic Health Records on June 23rd, 2010 | 1 Comment »

By, MacKenzie Kimball

During the American Health Information Management Association’s (AHIMA) Long-Term and Post-Acute Care (LTPAC) Health Information Technology (HIT) Summit, held June 7-8 in Baltimore, MD, industry leaders and representatives from a variety of organizations met to discuss the future of HIT in LTPAC settings.

Eric Dishman, director of health innovation and policy at Intel Corporation and the keynote speaker, kicked off the summit with a presentation on the shift away from long-term care facilities to home and community-based care in the near future.

This model of care is very different from the current model of institutionalized long-term care and will transform how providers deliver services and brand their organizations. During his presentation, Dishman outlined the major building blocks of community-based care systems, which are as follows:

• Care coordination
• Telehealth/e-care capabilities
• Social network/online communities
• Virtual call center capability
• Remote fleet management
• Service aggregation
• Broadband to community
• Volunteer training/management

Dishman believes that to successfully build community-based care systems, long-term care facilities will have to partner with other organizations, such as local businesses, physicians, dentists, and technology companies. In addition to partnerships, the community-based care model will also rely heavily on the use of electronic health records (EHR) and the interoperability of HIT systems, which were main focuses of discussions throughout the summit.

Although LTPAC providers were not included in the EHR adoption incentive program of the Health Information Technology for Economic and Clinical Health (HITECH) Act, speakers at the AHIMA summit emphasized the importance of EHR use by these providers. One reason for LTPAC providers to begin EHR adoption efforts is that incentive programs may eventually be expanded to include these providers.

As outlined in the LTPAC HIT Roadmap for 2010-2012, which was unveiled at the summit, the LTPAC Collaborative will be “advocating for full participation, consideration, and benefits for LTPAC providers in national, state, and regional HIT incentives, investments, and initiatives.” In addition, the HITECH Act requires the secretary to conduct a study on whether incentive payments for EHR adoption should be available to other providers.

According to Jennie Harvell, M.ed., senior policy analyst in the Office of the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services, this study should be completed in October and delivered to Congress in December. LTPAC organizations that begin EHR adoption and implementation efforts now will be in better positions if and when incentive programs are expanded to include other providers.

Implementing EHRs is a step in the right direction, but providers will reach a stand-still if their HIT and EHR systems are not interoperable, meaning information cannot be exchanged with other providers. Currently, a major barrier to interoperability between LTPAC providers is the inability to compare information collected using the different assessment tools—nursing homes use the MDS, home health agencies use the Outcome and Assessment Information Set (OASIS), and inpatient rehabilitation facilities (IRF) use the patient assessment instrument (PAI).

CMS is in the process of exploring one solution to this problem with the Post-Acute Care Payment Reform Demonstration (PAC-PRD), which makes use of the Continuity, Assessment, Record, and Evaluation (CARE) instrument.

The CARE instrument is an assessment tool that can be used by SNFs, home health agencies, and IRFs, instead of their respective assessment instruments. During the summit, Shannon Flood, technical project officer for PAC-PRD in CMS’ Office of Research Development and Information, informed attendees that CMS is finished with the data collection phase of the demonstration and is currently doing analysis. “We plan to submit recommendations for payment reform next year, but will need congressional authority to then move forward,” Flood said.

When asked if the CARE tool could be tied to payment bundling projects in the future, Flood responded, “Maybe. The long-term goal would be to combine the MDS, OASIS, and the PAI into one. But we really are at a pre-policy decision point.”

Although a wide variety of technology-related topics were covered during AHIMA’s LTPAC HIT Summit, the overall message was clear: healthcare is becoming more and more reliant on technology and LTPAC providers must adapt to the changing industry if they want to remain valuable players in the field.

Source: http://www.healthleadersmedia.com/page-1/TEC-252441/AHIMA-Summit-Highlights-Future-of-HIT##

Filed under: EHR, Electronic Health Records on June 17th, 2010 | 3 Comments »

Health and Human Services Secretary Kathleen Sebelius last week announced $83.9 million in grants to help networks of health centers implement electronic health records and other healthcare-related IT systems.

The grants are part of the $2 billion allotted to HHS’ Health Resources and Services Administration under the American Recovery and Reinvestment Act of 2009 to expand healthcare services to low-income and uninsured individuals through its health-center program.

“We need health information technology to bring our healthcare system into the 21st century,” Sebelius said. “This essential technology improves the quality of care we all receive and helps make care more efficient.”

Forty five grants will support new and enhanced EHR implementation projects as well as HIT innovation projects. Grantees will be able to use EHR technology to improve healthcare quality, efficiency and patient safety. Those healthcare providers who are able to demonstrate meaningful use of certified EHR technology may be eligible for incentive payments provided under Medicaid and Medicare.

“These funds will help safety-net providers acquire state-of-the-art health information technology systems as they work to provide quality healthcare to millions of people in need,” HRSA Administrator Mary Wakefield said.

Source:http://www.executivegov.com/2010/06/hhs-awards-83-9m-to-assist-in-adoption-of-ehrs/

Filed under: EHR, Electronic Health Records on June 11th, 2010 | 2 Comments »

Electronic health records can significantly expedite treatment for patients with Chlamydia, according to a study published online Thursday in the journal Sexually Transmitted Infections, HealthDay/U.S. News & World Report reports.

For the study, researchers examined the medical records of 100 patients who were treated at a sexual health clinic either before or after it converted to an EHR system.

Researchers found that before the clinic adopted EHRs, it took an average of 11.5 days for a patient to be treated after a Chlamydia diagnosis, compared with 3.5 days after the clinic switched to EHRs.

In addition, the percentage of patients who were treated within two weeks of testing positive for Chlamydia increased from 38% before the EHR system to 94% after the clinic implemented the EHR system (HealthDay/U.S. News & World Report, 5/27).

Above article publish on

http://www.ihealthbeat.org/articles/2010/5/28/study-ehrs-speed-up-treatment-of-patients-with-chlamydia.aspx

Filed under: EHR, Electronic Health Records on June 1st, 2010 | 1 Comment »

Nearly 70% of health care providers expect to hire a professional services firm to help them achieve “meaningful use” of electronic health records, according to a new report from research firm KLAS, Healthcare IT News reports.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of EHRs will qualify for Medicaid and Medicare incentive payments.

Report Findings

For the report, KLAS researchers interviewed 118 health care providers (Monegain, Healthcare IT News, 5/18). They found that integrated delivery networks had the highest need for external expertise, with 90% reporting plans to collaborate with consulting firms (Guerra, InformationWeek, 5/20).

Trend Toward Specific Tasks

Researchers noted that many health care providers already have achieved some level of health IT adoption and now are seeking to hire smaller groups to complete specific tasks.

Mike Smith — report author and KLAS general manager of financial and services research — said many health care organizations hire consultants to help bolster physician adoption of clinical information systems (InformationWeek, 5/20).

Above article publish on http://www.ihealthbeat.org/articles/2010/5/21/report-tracks-demand-for-consultants-to-help-with-health-it-adoption.aspx

Filed under: EHR, Electronic Health Records on May 24th, 2010 | 2 Comments »

The Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health IT is seeking patient perceptions of the delivery of healthcare through the use of an EHR.

“Health IT experts agree that HITECH stimulus funds are likely to improve how physicians practice medicine for Medicare and Medicaid beneficiaries and, ultimately, for advancing patient-centered medical care for all Americans. However, there is an evidence gap about patients’ preferences and perceptions of delivery of health care services by providers who have adopted EHR systems in their practices,” the HHS’ May 14 notice in the Federal Register stated.

According to the notice, the goal of the proposed Patient Perceptions of EHR study is to help policymakers understand how primary care practices’ use of EHRs affects consumers’ satisfaction with:

• Their medical care,
• Communication with their doctor
• Coordination of care.

“The research questions for the proposed study are motivated by a concern that patients may have negative experiences as practices begin to use EHRs,” the agency wrote.

HHS plans to survey 840 patients about their opinion of their medical care when their primary care physicians use EHRs, according to the notice, which can be read here.

Above article publish on http://www.healthimaging.com/index.php?option=com_articles&view=article&id=22235:hhs-to-study-patient-perceptions-of-ehrs

Filed under: EHR, Electronic Health Records on May 19th, 2010 | No Comments »

On Tuesday, Wisconsin Gov. Jim Doyle (D) signed into law the WIRED for Health Act (AB 779), which will create an entity to oversee the establishment of a statewide electronic health record system, the Milwaukee Journal Sentinel reports (Boulton, Milwaukee Journal Sentinel, 5/11).

Wisconsin is receiving $9.4 million through the 2009 federal economic stimulus package to plan and develop the statewide network.

The law will create a not-for-profit corporation to apply for additional federal funds to cover the cost of the system (AP/Lacrosse Tribune, 5/12).

At an event to mark the enactment of the bill, Doyle said the EHR network would allow health care providers to access patient medical data from other facilities throughout Wisconsin (Olds, WKBT, 5/11).

Possible Challenges

Officials noted that the project could face challenges in:

• Establishing interoperability standards for EHRs;
• Ensuring the privacy and security of patient data; and
• Reining in additional costs (Milwaukee Journal Sentinel, 5/11).

Above article publish on http://www.ihealthbeat.org/articles/2010/5/12/wisconsin-passes-law-to-establish-statewide-ehr-exchange-system.aspx

Filed under: EHR, Electronic Health Records on May 18th, 2010 | 2 Comments »

By Chelsey Ledue

WASHINGTON – After signing the healthcare reform bill into law on March 23, President Barack Obama traveled to Iowa and Maine to promote his vision, which includes the role of healthcare IT in saving lives and cutting cost.

Obama visited Iowa City, Iowa on March 25 and Portland, Maine on April 1.

At the Maine rally, Obama said passage of the healthcare reform law is a reminder that the country has the power to shape its own destiny.

“It has reminded us that we, as a people, do not shrink from a challenge,” he said. “We overcome it.”

Obama has had a history of supporting healthcare IT advancement, which includes a call for every American to have an electronic health record by 2014. The president requested $110 million in his budget this year, to strengthen healthcare IT policy coordination and research activities.

Last year, the administration backed more than $20 billion over 10 years to advance healthcare IT adoption in the American Recovery and Reinvestment Act (ARRA).

At the president’s rally in Portland, Maine Gov. John Baldacci touted healthcare IT as the means for improving quality of care, noting that Maine has been an early leader in the adoption of medical technology.

Information technology “plays a huge role” in medical reform, Baldacci told Healthcare IT News. “A huge role. It’s going to be through medical information technology that you’re going to enhance the ability of the providers to give quality care but also do it in a way that will reduce costs. It’s a critical element that needs to be part of this.”

David Howes, a physician and CEO of Portland, Maine-based Martin’s Point Health Care, said the reform law is “an enormous step forward.”

“The bill builds support for primary care and EHRs,” Howes said. “It contains flexibility and support for new models of care and Medicare quality and effectiveness measures. It is an enormous step forward for the American people and businesses.”

“I think it’s an opportunity for the president to help market the good parts of the bill,” said Gordon H. Smith, executive vice president of the Maine Medical Association, prior to the president’s visit. “I think it’s a battle for the hearts and minds of the public.”

Above article publish on http://www.healthcareitnews.com/news/obama-launches-national-campaign-sell-health-reform-health-it

Filed under: EHR, Electronic Health Records on May 12th, 2010 | 1 Comment »

By Neil Versel

Electronic health records (EHRs) have been around in one form or another since the 1960s, but the notion of patient records being stored on computers is only beginning to seep into the public’s consciousness. While pretty much every other industry computerized years ago, the vast majority of Americans’ medical records remain on paper.

The goal of electronic health records (and health information technology in general) is to make health care safer and more efficient by providing health professionals and patients alike with information to inform decision-making, promote preventive care and reduce duplication.

It sounds simple enough, but health IT is a complex, frequently misunderstood topic. In this essay, I’ll provide some background on electronic health records and health information technology, a glossary of terms, and some story ideas, with the goal of helping you better cover this important health and business topic.

Ditching paper charts is not easy, nor is writing about the conversion. The central story is not the technology itself, but rather how health information technology will transform care. “It’s really a matter of change management rather than technology,” Dr. David Blumenthal, the Obama administration’s national coordinator for health IT, explained in November 2009.

Online health records for all – “in 10 years”

First, some background: in 2004, President George W. Bush called for “most Americans” to have electronic health records within 10 years and created the Office of the National Coordinator for Health Information Technology within the Department of Health and Human Services to help make it happen. One early project of the office was the attempted conversion of VistA, the EHR long in place at the Department of Veterans Affairs, for use in small medical practices. The EHR, which was difficult to install in most doctors’ offices, never made it past a beta version before federal officials dropped the project.

Health IT subsequently drifted in and out of the national spotlight over the next several years, but didn’t garner much coverage in the mainstream press unless there was a local angle, such as a hospital installing a system. As a longtime reporter on this beat, it has been a challenge to “sell” this story outside the trade press. But now that health information technology is a major story, with plenty of interesting national and local angles, I’ve noticed more reporters scrambling to grasp this difficult subject.

So what’s finally turning arcane health information technology into a mainstream news story? Two things: National health reform and the federal stimulus bill.

Health Reform: Can Better Health IT Lower Costs and Improve Care?

Now that health insurance reform legislation[NV1]  has passed, I hope mainstream media will turn their attention to a major health information technology story:  greater access to health care does not guarantee good care, so it won’t matter much whether government or private companies administer health plans for millions of new enrollees as long as fee-for-service remains the dominant payment model.

The perverse reality is that mistakes can be good for business. Medical errors and other complications lead to more hospitalizations and longer stays. Both the fear of being sued and the inability to access previous results cause doctors to order extra tests, without regard to medical prudence.

Health IT can help prevent errors by offering what’s known as clinical decision support — computerized alerts recommending best practices and warning against harmful actions, such as prescribing a medication to which a patient is allergic. EHRs, if properly connected to laboratory systems, make test results more readily available so there is less need to re-order procedures. A good EHR should keep a record of every instruction a doctor gives to a patient so there is no question what was or was not communicated, in case of a malpractice claim.

From the perspective of a health IT reporter, health reform started not with the bills President Obama signed in March 2010, but more than a year earlier with the passage of the $787 billion stimulus bill, also known as the American Recovery and Reinvestment Act. The 2009 legislation contains an estimated $25.8 billion for health IT, mostly in the form of incentives [NV2] for doctors and hospitals to adopt electronic health records. Those that have not ditched their paper charts by 2015 face lower Medicare and Medicaid reimbursements.

Insurers and employers that provide health benefits tend to reap the greatest financial rewards from EHRs, so there has been little incentive for the actual providers of health care – physicians and hospitals – to invest in technology. The stimulus is supposed to change the paradigm by rewarding providers that demonstrate “meaningful use” of EHRs beginning in October 2010 for hospitals and January 2011 for physician practices.

According to rules proposed at the end of 2009, EHRs should provide clinical decision support, doctors and nurses should enter orders electronically, patients should be able to get a copy of their medical records on demand and users should be able to share data between facilities and organizations. The requirements will get tougher in 2013 and again in 2015; providers eventually will have to prove that they follow nationally recognized standards of practice.

As electronic health records – and subsets of them like personal health records – become more of a hot topic for mainstream media, it’s important to learn the lingo and get your facts straight.

Know your acronyms: a cautionary tale

Here’s what can happen if you don’t: On Dec. 2, 2009, a website called eSecurity Planet published a story  about a privacy watchdog organization publishing a pre-emptive strike against personal health records, a subset of EHRs that has virtually zero market traction to date.

The eSecurity Planet story confused consumer-oriented personal health records for “electronic medical records” and wrongly reported that the stimulus is paying for billions in “electronic personal health records (PHRs).” The stimulus is supporting EHRs, a much broader category. Additionally, the story, like far too many others I’ve read, referred to the much-hyped Google Health and Microsoft HealthVault platforms as market leaders. They are nothing more than early-stage products from big names in the consumer arena, not established health IT powerhouses.

Look past the hype, learn the terminology and talk to people on the front lines. Go to the chief information officer and nursing shift managers of a local hospital. Physicians in private practice should have plenty to say as well.

This subject is often tough to grasp, so don’t be afraid to ask seemingly simple questions. I’ve been covering health IT since 2001, and I still frequently need detailed explanations.

Story ideas for your community

As implementation of national health insurance reform begins and EHR money starts flowing from the stimulus bill, I hope you’ll consider these story ideas for your community.

1. Who owns your EHR[NV3] ?  Should you be concerned about it being used as a source of information for pharmaceutical researchers or medical marketers?

2. What is your local hospital or large medical group doing to get stimulus money for EHR development? What differences might patients see as a result?

3. How will the physician office visit change as a result of computerization? Will patients be asked to complete medical history forms online rather than filling out the ubiquitous clipboard each time they go to the doctor? Will nurses and physician assistants be able to provide services once the exclusive domain of physicians because if they have access to more complete patient information?

4. How might patients get better preventive care if medical practices are able to generate, with the help of EHRs, automatic reminders for recommended screening based on age, gender and health risk factors?

Above article publish on http://www.reportingonhealth.org/resources/lessons/covering-electronic-health-records

Filed under: EHR, Electronic Health Records on May 10th, 2010 | 1 Comment »